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02/25/2015 DHHS Statewide CQI Meeting 1
CONTINUOUS QUALITY IMPROVEMENT (CQI)
Adult Protective Services
Our Vision: To prevent and reduce harm to vulnerable adults from abuse, neglect, and exploitation utilizing the least restrictive methods.
Our Commitments :1. Adults have the right to be safe2. Adults retain all their civil and constitutional rights unless a court
adjudicates otherwise3. Adults have the right to accept or refuse services4. Adults have the right to make decisions that do not conform with societal
norms as long as these decisions do not harm others
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TABLE OF CONTENTSChapter 1: Prevention and Early Intervention…………………………………………………………………... 3
Adult Protective Services Intakes – 2008 to 2013.…………………………………………………………………………………………………………... 4Adult Protective Services Intakes – Current Calendar Year (2014)………………………………………………………………………………………. 5
Chapter 2: Safety…................................. ....................................................................................................... 6Intake/Hotline Calls……………….…………………………………………………………………………………………………………………………… 7Intake/Hotline Quality Measures………….…………………………………………………………………………………………………………………. 8APS Accepted Intakes vs. Vulnerable Adults………………………………………………………………………………………………………………. 9APS Face to Face Contact Time Frames…………………………………………………………………………………………………………………… 10APS Investigation Timeframes – Ready for Review Status……..………………………………………………………………………………………… 11APS Investigation Timeframes – Final Status from Ready for Review…………………………………………………………………………………. 12APS Investigation Timeframes – Final Status from Intake .………….………………………………………………………………………………….. 13APS Quality Measures – Statewide ………………………..………………………………………………………………………………………………. 14APS Quality Measures – Eastern Service Area………………………..…..……………………………………………………………………………… 15APS Quality Measures – Southeast Service Area…..……………………………………………………………………………………………………. 16APS Quality Measures – Central Service Area……………………………………………………………………………………………………………. 17APS Quality Measures – Northern Service Area………………………………………………………………………………………………………….. 18APS Quality Measures – Western Service Area…………………………………………………………………………………………………………… 19
Chapter 3: Workforce Stability…………………………………………………………………………………….. 21CFS Staff Vacancy Rate…………………………………………………………………………………………………………………………………....... 22Average Number of Investigations per APS worker per month ………………………………………………………………………………………….. 23
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CHAPTER 1: Prevention and Early Intervention
• OUTCOME STATEMENT: COMMUNITIES WILL HAVE AN UNDERSTANDING AND OWNERSHIP OF PREVENTING AND INTERVENING IN THE PROTECTION OF VULNERABLE ADULTS FROM ABUSE, NEGLECT, OR EXPLOITATION.
• Goal Statement: Increase the public’s awareness of the role of Adult Protective Services.
Adult Protective Services Intakes – Past Years
Strengths/Opportunities:The number of accepted APS intakes has increased each year since 2008.
2014: Overall, there were 37 more intakes accepted than in 2013. Several service areas had a lower number of intakes received than in 2013. (CSA, NSA, and SESA).
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Communities will have an unders tanding and ownership of preventing and intervening in the protection of vulnerable adults from abuse, neglect, or exploitat ion
Adult Protective Services Intakes –Current Year (2015)
Strengths/Opportunities:February 2015: New chart to show the accumulated intakes for the current year for each month.
Barriers:
Action Items:*Completed:
*Planned:
Totals for the current year:CSA: 29
ESA: 87
NSA: 40
SESA: 56
WSA: 33
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Data Review Frequency: Monthly
This data reflects all the APS Intakes during the reporting month including accepted intakes and intakes not accepted.
Source: 2015-01 Intake QA Report
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CHAPTER 2: Safety
• OUTCOME STATEMENT: VULNERABLE ADULTS IN THE ADULT PROTECTION SYSTEM ARE SAFE.
• Goal Statement #1: Adult protection and safety staf f are committed to integrating Structured Decision Making into all aspects of work
• Goal Statement #2: Vulnerable adults will receive a timely response from Adult Protective Services
• Goal Statement #3: Adult Protective Services ensure the safety and dignity of vulnerable adults using the least restri ctive interventions
Intake Calls / Responses –All Calls & APS Breakout
Strengths/Opportunities:January 2015: Breakout of all calls shows that 13.0% of the total calls were for Adult Protective Services investigations.
Barriers:
Action Items:*Completed:
Definitions for each type of call are below the chart.
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
APS Info / Referral: Caller wants information or needs a referral to a community resourceAPS Investigation: Caller intends to make an APS reportCPS Info / Referral: Caller wants information or needs a referral to a community resource for childrenCPS Coverage: Caller needs information on an open case
CPS Background Checks: Requests for background checks to be completed for placementCPS Child Abuse/Neglect : Caller intends to make a CPS reportDefault : Calls not keyed-in at allOther: Calls that are general questions that do not fit into any of the other categories and do not generate a report, NFOCUS documentation, or notification to another HHS employee
Intake Quality Measures –APS Only
Strengths/Opportunities:November 2014: Data indicates that APS intakes are received with enough detail to determine if the report met the screening criteria and if the victim may or may not be a vulnerable adult.
Barriers:
Action Items:*Completed:
*Planned:
Note: This is a quarterly review.
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Data Review Frequency: Quarterly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Adult Protective Services Intakes vs. Vulnerable Adults
Strengths/Opportunities:October 2014: Increases in the number of vulnerable adults for APS investigations and Org. Related investigations.November 2014: Slight increase in the number of vulnerable adults for APS investigations and self neglect investigations. December 2014: Data remains consistent for APS and ORG investigations, but decreased for Self-Neglect cases. January 2015: Lower number of APS intakes with a vulnerable adult. Higher number of self-neglect intakes with a vulnerable adult.
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Communities will have an unders tanding and ownership of preventing and intervening in the protection of vulnerable adults from abuse, neglect, or exploitat ion
Vulnerable Adult (28-371): Vulnerable adult shall mean any person eighteen yeas of age or older who has a substantial mental or functional impairment or for whom a guardian has been appointed under the Nebraska Probate Code.
APS Face to Face Contact Timeframes
Strengths/Opportunities:November 2014: Decrease in P1 face to face contact time frames, but increases in P2 and P3 face to face time frames!
December 2014: P1 face to face timeframes returned to 100%!. P3 face to face timeframes were met less than 100% in December.
January 2015: P1 and P2 face to face contact time frames are at 100%! P3 face to face time frames increased to 99.2%.
Barriers:
Action Items:*Completed:
Note: Exceptions to face to face contacts are not reflected in the charts.
This data is measured for intakes accepted in January 2015.
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measures are from the APS Performance Accountability report on Infoview. Source: 2015 – 01 APS Performance Accountability
APS Investigation Timeframes –In Ready for Review Status
Strengths/Opportunities:November 2014: P1 and P2 timeframes for investigations in ready for review status increased.
December 2014: P2 and P3 timeframes both increased in timeliness for ready for review status in December.
January 2015: Increase in P1 and P2 timeframes for ready for review status and slight decrease for P3 timeframes.
Barriers:Financial exploitation cases are considered a barrier to achieving this measure due to the time requirements involved in that type of investigation.
Action Items:*Completed:
Note: Exceptions to finalization timeframes are not reflected in the charts.
This data is measured for intakes accepted in November 2014.
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measures are from the APS Performance Accountability report on Infoview. Source: 2015 – 01 APS Performance Accountability
APS Investigation Timeframes –In Final Status from Ready for Review
Strengths/Opportunities:November 2014: P3’s had a slight decreased for finalization time frames within 10 days of ready for review status.
December 2014: P1 and P2 timeframes remained consistent, with an increase in P3’s being finalized in 10 days of ready for review status.
January 2015: Data remained consistent for P1 and P2 timeframes and decreased slightly for P3 timeframes.
Barriers:
Action Items:*Completed:
Note: Exceptions to finalization timeframes are not reflected in the charts.
This data is measured for intakes accepted in November 2014.
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measures are from the APS Performance Accountability report on Infoview. Source: 2015 – 01 APS Performance Accountability
APS Investigation Timeframes –In Final Status from Intake
Strengths/Opportunities:November 2014: Slight increase in P2 finalization time frames and slight decrease in P3 finalization time frames.
December 2014: Slight decrease in P1’s being finalized timely, with slight increases in P2’s and P3’s meeting the required finalization time frames.
January 2015: Slight decrease for P1’s, with an increase in P2’s into final status. P3 timeframes remained consistent.
Barriers:
Action Items:*Completed:
Note: Exceptions to finalization timeframes are not reflected in the charts.
This data is measured for intakes accepted in November 2014.
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measures are from the APS Performance Accountability report on Infoview. Source: 2015 - 01 APS Performance Accountability
APS Quality Measures -Statewide
Strengths/Opportunities:August 2014: Statewide increases in all areas! (95% or above in all areas!)
September 2014: Many items remained consistent. Decreases in supporting the maltreatment and safety sections statewide.
October 2014: 3 out of 5 measures remained steady, while 2 increased statewide.
November 2014: 3 out of 5 measures decreased, while two measures increased for the state.
December 2014: 3 measures at 100% and increases in all 5 measures!
January 2015: Decrease in two measures, with an increase in the Safety Response area!
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measure is from CQI reviews of the APS investigation summary. Random samples from each service area are selected and reviewed on a monthly basis.
APS Quality Measures -ESA
Strengths/Opportunities:August 2014: Increase in all areas except the maltreatment section!
September 2014: Most areas remained steady except for Maltreatment.
October 2014: Increases in 3 out of 5 areas!
November 2014: Increase in only two areas since last month.
December 2014: 100% in 4 measures and increases across the board!
January 2015: Decrease in two areas with 100% in 3 measures!
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measure is from CQI reviews of the APS investigation summary. Random samples from each service area are selected and reviewed on a monthly basis.
APS Quality Measures -SESA
Strengths/Opportunities:August 2014: 100% for all areas in the August 2014 reviews!
September 2014: Decreases in the maltreatment sections and the safety section.
October 2014: Increases across the board for SESA!
November 2014: Several measures remained at 100%, while there was a significant decrease in the safety measure.
December 2014: Increases in each measure and 100% in 3 out of 5 measures.
January 2015: 100% in 3 out of 5 areas, with decreases in two areas.
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measure is from CQI reviews of the APS investigation summary. Random samples from each service area are selected and reviewed on a monthly basis.
APS Quality Measures -CSA
Strengths/Opportunities:August 2014: Slight decrease in the alleged victim section and safety response section for CSA. September 2014: Large decrease in support for the safety response section in this case.October 2014: Decrease in the Maltreatment section and large increase in Safety Response section. November 2014: 100% across the board except for the safety measure. December 2014: 100% in every measure except the safety response. Large increase to the safety response measure.January 2015: 100% in 4 of the measures across the board.
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measure is from CQI reviews of the APS investigation summary. Random samples from each service area are selected and reviewed on a monthly basis.
APS Quality Measures -NSA
Strengths/Opportunities:August 2014: 100% in 4 out of 5 measures for the month.
September 2014: 100% across the board for NSA!
October 2014: Decreases across the board for all of the measures.
November 2014: Several 100% measures with a few small decreases in two measures.
December 2014: Several 100% measures with two increases in other measures!
January 2015: 100% across the board for all 5 measures!
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measure is from CQI reviews of the APS investigation summary. Random samples from each service area are selected and reviewed on a monthly basis.
APS Quality Measures -WSA
Strengths/Opportunities:August 2014: Increase for all measures into 100% for the month!
September 2014: 100% across the board for WSA!
October 2014: 100% across the board for WSA again!
November 2014: 100% across the board except for the alleged victim measure.
December 2014: 100% across the board except for the Safety Response section.
January 2015: 100% across the board for all measures!
Barriers:
Action Items:*Completed:
*Planned:
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Data Review Frequency: Monthly
OUTCOME STATEMENT: Vulnerable adults in the Adult Protection System are safe
Note: Measure is from CQI reviews of the APS investigation summary. Random samples from each service area are selected and reviewed on a monthly basis.
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CHAPTER 3: Workforce Stability
• OUTCOME STATEMENT: THE ADULT PROTECTIVE SERVICES’ WORKFORCE IS WELL-QUALIFIED, TRAINED, SUPERVISED, AND SUPPORTED.
• Goal Statement #1: Reduce staff turnover• Goal Statement #2: Provide for ongoing training for staff
that addresses the skill and knowledge base needed to carry out their duties
• Goal Statement #3: Supervisory staff will be well t rained and provide overall leadership for workers
APS Staff Vacancy Rate
Strengths/Opportunities:
Barriers:
Action Items:*Completed:
*Planned: In the future, APS Staff could have their own classification.
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Data Review Frequency: Monthly
OUTCOME STATEMENT: The Adult Protective Services’ workforce is well-qualified, trained, supervised, and supported
# of Positions Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15
CSA 4 0.0%
ESA 11 0.0%
NSA 5 0.0%
SESA 7 0.0%
WSA 4 0.0%
Total 31 0.0%
APS Only Vacancy Rate
Source: Self-Report from all the Adult Protective Services Supervisors.
Average Investigation Per APS Worker Per Month
Strengths/Opportunities:The average number of APS intakes per worker per month increased slightly from 2012 to 2013.
2014: The average number of intakes per worker increased from 2013, but several service areas decreased.
Barriers:
Action Items:*Completed:
*Planned:
Note: The number next to each service are represents the total allotted positions for the current year (2014).
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Data Review Frequency: Monthly
OUTCOME STATEMENT: The Adult Protective Services’ workforce is well-qualified, trained, supervised, and supported
This data only represents new investigations. It does not reflect the number of ongoing cases managed by APS.
Self Neglect APS Investigation ORG Related
CSA 3.5 2.9 1.2
NSA 2.3 3.1 1.3
WSA 3.1 3.5 1.1
SESA 2.4 2.9 1.3
ESA 2.1 4.1 1.8
Average Number of New Investigations Per Worker Per Month - 2014
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Prepared by:
Nebraska Department of Health and Human ServicesChildren and Family Services
Research, Planning and Evaluation Unit402-471-5361